Midwifery Today Conference News

Italian midwife Verena Schmid, one of the teachers for the August intensive, is in the United States now, at Nancy Wainer's in Boston. Verena then plans to visit the Farm in Tennessee, then Jeannine Parvati Baker and on to the San Francisco area, hopefully to visit Elizabeth Davis. When she comes to Eugene, I will take her on a trip visiting more midwives, schools and birth centers in Oregon. It will be exciting to see what Verena has learned in her travels around the United States meeting birth practitioners. Her insights are always astounding in their depth.

Verena has a school for midwives in Italy and has also spoken in hospitals across that country. There is a map of Italy on her wall with a pin of one color for every hospital she has spoken in, and another for upcoming talks. The map is covered with pins.

Besides being a midwife for 25 years, Verena plans to start a birth center. She has put on many conferences herself and speaks in various parts of Europe. Verena and I have even talked about doing a joint conference in Italy. I can't wait to see how this trip has affected her already deep knowledge of childbirth. I am anxious to learn about the similarities and differences between birth and midwifery here and in Italy. I especially like Verena's concept that if we address issues and do enough in the prenatal period with women then the birth will go well. I am thrilled that she has agreed to come and teach us about how she addresses those issues with women.

Quote of the Week

"The women I have served as a midwife over many years taught me how interesting, subtle and complex women really are."

- Marion Toepke McLean

The Art of Midwifery

As a La Leche League leader, I strongly recommend this simple, effective way to increase milk supply: NURSE! NURSE! NURSE! Because milk is produced by supply/demand, the more your nursling is at the breast, the better your milk supply. If you are concerned, try "super switch nursing" -- as soon as your babe slows on one breast, immediately switch to the other. Repeat this process. Offering both breasts at every feeding is also a good way to stimulate milk production. This supply/demand process is the underlying reason why babies nurse more frequently during growth spurts. Not only do they want more milk, but they are building up mother's milk supply by needing more time at the breast.

News Flashes

Previous research has shown that alcohol consumption by pregnant women is one of the leading preventable causes of birth defects and developmental disabilities, yet when researchers reviewed 81 clinical obstetric texts in current use, they found that only 14 contain a consistent recommendation that pregnant women should not drink alcohol. Among the 29 texts published since 1991, only seven consistently recommend abstinence. More than half of the 81 texts contain at least one statement condoning drinking. Although none of the 29 texts published since 1991 contains a consistent message that drinking is permissible during pregnancy, 15 carry a mixed message, recommending abstinence in one place and stating elsewhere that some level of drinking is permissible.

Midwifery Today Magazine

Herbal Remedies for Normal Childbirth

The birth kit is a prepared and easily transportable package of herbal remedies intended for use in normal childbirth. Any and all of the following can be beneficial to have handy to help facilitate normal birth. In the following list, I offer information about natural, safe and effective herbal remedies that are tried and true and long valued by women worldwide as allies for the transformative process of childbirth.

Blue/black cohosh roots combination (Caulophyllum thalictroides, Cimicifuga racemosa): Establishes and regulates labor. Blue cohosh especially carries a significant amount of oxytocin, which is responsible for initiating and mainaining the process of labor. Black cohosh helps labor progress without intensity, taking the edge off powerful contractions and allowing the mother to remain open. Take 15 drops of the tincture in a cup of warm water every half hour until a good rhythm is established.

Ginseng/ginger roots combination (Panax, Zingiber officinale): Lends energy during labor and birth. Ginseng is renowned as a strengthening tonic overall and is useful in difficult or prolonged labor in which the mother feels exhausted and unable to go on. Ginger root is a warming, stimulating tonic that will give a boost while easing contracting muscles. Use 20 drops of tincture hourly as needed. As labor moves into the pushing stage, a one-time dose of 30-40 drops can be used to boost energy.

Skullcap/passionflower combination (Scutellaria laterifolia, Passiflora incarnata): Specific for pain relief and nerve nourishment. Helps settle the nervous system and adrenals, helps reduce fears and anxiety, particularly when the fear of pain becomes greater than the pain itself. This formula also can be used if the blood pressure rises above an acceptable normal range. This combination can be taken following the delivery to help settle and relax the mother. Use 10-20 drops of tincture hourly, or every half hour if necessary as labor deepens.

Yarrow/shepherd's purse (Achillea millefolium, Capsella bursa-pastoris): These are wonderful to have on hand in case of unchecked postpartum bleeding. They are renowned hemostatics that help control excessive blood flow. This tincture must be prepared with fresh flowering shepherd's purse. The dried herb is not as effective. Use 10-15 drops of this formula, only after the placenta has been delivered, every 15 minutes until bleeding is under control.

Dong quai (Angelica sinensis): Encourages the expulsion of a reluctant placenta. This herb usually yields good results within one or two doses. Take 15 drops of dong quai tincture every 15 minutes for three doses.

Rescue Remedy: This is a classic flower essence combination from the Dr. Edward Bach school of flower essence therapy. The five flowers of this formula -- clematis, star of Bethlehem, rock rose, cherry plum and impatiens -- were chosen for their specific and synergistic effect on the spirit following a shock, trauma or any intensely moving experience. To use it, nothing need be "wrong." Administering a few drops to everyone in the birthing party following delivery can be a grounding and unifying ritual. Use a dose of 3-5 drops under the tongue once or up to every 15 minutes for an hour.

Mugwort flower essence: For connection to the spirit world when seeking guidance and strength; attunement to the incoming soul. Use 2-4 drops on the tongue as desired.

Walnut flower essence: Releasing the child and the pregnancy; transitioning to the next level of the mother-child relationship. Use 2-4 drops as needed.

Red hibiscus flower essence: Universal feminine power, sexual/creative power of women, tapping into the goddess-self who is capable of anything. Use 2-4 drops as desired.

Chamomile essential oil: Carries concentrated benefits of its relaxing, warming and soothing properties. Most notably a classic antispasmodic herb. Add the essential oil to a hot tub for labor or dispersed in a carrier oil for massage. It will relax the muscles, ease pain, calm the spirit and help the laboring mother remain open to birthing energy.

Comfrey leaf (Symphytum officinale): The healing powers are unparalleled in the ability to quickly repair tissues and bones. The herb in infusion form can be used topically for any perineal tears, stitches or general soreness in the pelvic floor. Soak in a comfrey sitz bath several times a day. The bath can be prepared by adding a quart of comfrey leaf infusion to a quart of warm water and mixing these in the sitz bowl before use. Soak up to 20 minutes each time.

Other Products of Interest

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INTERNATIONAL ALLIANCE OF MIDWIVES
Midwifery Today's Web-based organization that networks international midwives.

Forum Talk: Polyhydramnios

I am a doula working with a woman who has been experiencing early labor for about 10 days, complete with bloody show, good contractions that react normally to movement, and she was even a bit dilated last week. This week she is still contracting, although not strongly, but is no longer dilated, and has been told by her midwife that she has polyhydramnios, and that baby may have a defect. Does anyone have any information or advice about how to deal with this situation?

- Mikki

Go to our forums to share your thoughts and experience.

Question of the Week: Hypertension

Q: Has anyone else noticed an increase in hypertension for women who conceived soon after 9-11? I just had five hypertensive clients in a row, and I normally only have a maximum of two each year.

Question of the Week Responses: Loose Stools

Q: Do readers have insight or remedies for a pregnant mother who has had loose stools all of first and second trimester? Why does this happen, and is it normal for some pregnancies?

- Anonymous

A: I am 7 months pregnant and have had this problem through most of my pregnancy. I just figured it was part of the hormonal changes occurring in my body. I drink plenty of water, eat well and have gained a normal amount of weight. My only thought was the possibility of developing lactose intolerance since becoming pregnant.

- Ramona

A: I had very loose stools through most of my pregnancy. My midwife put me on iron supplements and it seemed to help. I think I was constipated 1-2 times through my pregnancy and supposedly that's the norm. Talk to your midwife or doc about it, and don't forget to drink a lot of water!

- Donna

A: bet it is somehow related to all the relaxin in a mom's body during pregnancy. I had loose stools with both of my pregnancies, and afterward I returned to normal.

- Carla

A: Instead of throwing up every morning I got up and had diarrhea. This continued into my 3rd trimester. I did throw up some and had morning sickness up to 2 weeks before my baby was born. My midwife was unconcerned and said that some women just respond differently to the hormone surges. Overall, I had a very normal and healthy pregnancy, labor, birth and baby. My midwife helped changed my perspective on this matter to be grateful to be pregnant and not constipated!

- Liberty Coultas
San Antonio, TX

The BirthLove Web site has helped many women grow trust in birth and in their bodies. It has helped women resist Cytotec, find good midwives and stop believing everything their doctors say. There are hundreds of homebirth stories: unassisted VBAC, fathers' stories, twin (and triplet home VBAC!) stories, breech stories -- for things that people get sectioned for daily, there are homebirth stories on the site. Marsden Wagner, MD is a contributing expert, as is Sarah Buckley, MD, Gloria Lemay and Gretchen Humphries. BirthLove has changed and saved lives through education, communication and love. Become a member of BirthLove today and be inspired!

Question of the Quarter, Midwifery Today magazine

Issue 64, Unity

Is unity possible in this diverse midwifery community? Can we stand up for and support one another when there is such a range of philosophical approaches to training and practice?

All responses subject to editing for content and style. Sorry, but we cannot reply to each individual submission.

With Woman

by Gloria Lemay, compiled by Leilah McCracken

Hands Off the Breech!

These words are legend in obstetrics, yet many practitioners are seemingly unable to resist the temptation to meddle with the breech baby.

Hands off the breech applies to doing pelvics to see if the cervix is dilated to 10 cm. The woman should be told in advance that she will be asked to resist the urge to push for a full 45 minutes once her bearing down begins. That way the cervix will be out of the way of the aftercoming head. I have seen nurses declare the mother fully dilated and then discover there is still cervix in the way as the mother pushes.

Hands off the breech also refers to cleaning away meconium or lubricating the vaginal opening of the mother. The slightest outside stimulation can cause the baby to extend arms over the head or gasp.

Once the baby is born to the waist, the baby's spine should be pointing toward the symphysis pubis of the mother. Hands off at this point means wrap a receiving blanket that is folded like a strap around the baby's belly near the hips. Twist the ends of the strap into a handle and use that handle to keep the hands of the practitioner away from the baby during the rest of the expulsion. Gripping the baby's abdominal region during this time can cause damage to kidneys and other organs that are engorged with blood. The cloth strap disperses the pressure evenly all around the baby's body. If the arms have extended above the head, the midwife must reach in and pull down an elbow, one at a time. This is the ONLY part of the breech birth where the hands are used directly on the baby's body.

Hands off the breech again while the body dangles and brings the back hairline of the baby into view. Once the baby is born to the hairline of the neck, the body is lifted with the strap up toward the mother's symphysis pubis. Just the cloth handle is touched. This lifting upward of the body brings the mouth and nose into view, and at this point an airway is established. Everything should slow down and the top of the head is gently panted out. The only hands on part of the breech birth is to bring down arms that are up by the head. Usually the arms stay down at the sides if the breech birth has been hands off.

Feedback

The June 12 issue [Issue 4:24] carried a note from "Anonymous" who wrote asking for advice about balancing midwifery school and a young family because she has a "burning desire to be with women" and feels she must do this "NOW." My advice is to put off school until your children are grown. They came first and need you at home to take care of them, not to be sent to the daycare to be taken care of by someone else's mother. Your children deserve a mother who is on call for them, not her patients. Babies will continue to be born, but your children will only be young now. A wise man said, "Don't sacrifice the future on the altar of the immediate." Your desires can wait; their need for you can't.

- Joy Hearn
Kathmandu, Nepal

The article about difficult patients [Issue 4:23] is exactly why I choose to birth without a midwife for all my births. The condescending tone that implies that clients need to be soothed, consoled or patronized is no different than how OBs regularly treat their patients. Women about to give birth and during pregnancy are in the most powerful state of their lives, and they should be honored and loved. Midwives often forget that they are servants in the truest sense of the word. This is a serving profession; the woman is in charge, which is why she hired a midwife in the first place, not so she could be pyschoanalyzed and patronized. If more midwifes would understand that they should be quiet, respectful and honoring of each woman as an individual, there would be fewer women choosing unassisted birth. I chose unassisted birth for my first child (and all subsequent ones as well) because over and over the midwives I met were of the same mindset as the author of this article. I have yet to meet a midwife who knows her true role, that of a highly respectful doula who happens to know a lot. So for my births I hire a doula, which for most women is all the support they really need.

- A.
NJ

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